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OPTUM PHARMACY 702, LLC
RRC330023-00 VASSAR BROTHERS MEDICAL CENTER
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Covered Entity Details
Entity Name
VASSAR BROTHERS MEDICAL CENTER
Subdivision Name
Type
Rural Referral Center
340B ID
RRC330023-00
Entity Address
45 READE PLACE
POUGHKEEPSIE, NY 12601
Medicare Provider Number
330023
Participating Start Date
3/1/2022
Last Recertification Date
8/16/2024
Entity Termination Date
4/1/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
7/12/2022
Contract Begin Date
7/27/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Karen M Steele, VP of Pharmacy Services
(845) 472-9571
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/12/2022
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